Prescription Drug Cost Caps Take Effect

Three years ago, Charis Hill was 26, and she was diagnosed with a rare type of arthritis called Ankylosing Spondylitis. Basically, bone spurs are fusing her spine together. There’s one drug to treat it.

"That keeps me alive basically," Hill says. "That slows the disease—there’s no cure. But it’s also a really expensive drug."

Hill says when she first enrolled in an insurance plan through Covered California—that’s the state’s health insurance marketplace—a refill would have cost her $2,000. She couldn’t afford it, until she found a subsidy from the drug’s manufacturer.

Starting January 1st, Covered California limits how much insurance companies can require patients with hepatitis, HIV and other diseases requiring specialty drugs to pay for prescriptions. Most plans cap the cost of these specialty drugs at $250 per month.

Hill says the new policy provides security that she’ll be able to afford treatment.

"There’s certain level of fear that comes with living with a disease that doesn’t ever go away," Hill says. "And, going into a new medication knowing that I will not have to pay over $250 a month for it is good."

Insurance companies say that passes more of the drug cost to them, and they will be forced to raise premiums as a result.

In 2017, the caps will extend to all California health insurance plans.